The pathophysiology of sickle cell disease results from cellular defects caused directly by the Hb S mutation interacting with the environment and many other gene products—some known, but most yet unidentified–a typical example of epistasis. How normal tissue perfusion is interrupted is complex and why the phenotype of sickle cell disease differs from patient to patient is poorly understood. Answers to this question will provide additional insight into their biological and functional relationships.

Feasibility and challenges of addressing this CQ or CC:

Scientific advances make it feasible to identify additional epistatic genes, which will provide additional insight into their biological and functional relationships.

Name of idea submitter and other team members who worked on this idea:
The Sickle Cell Association of New Jersey

Research on the stem cell-niche interaction will enhance our understanding of stem cell behavior, enable manipulation of stem cell activity and differentiation potential, and facilitate the development of stem cell-based therapy.

Feasibility and challenges of addressing this CQ or CC:

Developing novel models for in vitro 3D culture and in vivo transplantation assays will facilitate the progress.

Recent advances have identified and characterized several lung progenitor cell types. However research gaps remain on understanding the interaction of stem cells with the niche, and how the microenvironment impacts on the stem cell activity during injury/repair.

Name of idea submitter and other team members who worked on this idea:
NHLBI Staff

Voting

Many biological models developed to date are based on studies using heterogeneous cell populations. For example, ChIP-Seq studies have shown that RNA Pol II is frequently paused near promotes and that in stem cells, developmentally poised genes are controlled by bivalent enhancers. These studies are largely based on statistical analyses of average ChIP-Seq reads from millions of cells. Earlier biochemical analysis of
...more »

It will also be helpful to develop bioinformatic methods for quantitative analysis of the single-cell-derived results. Using these assays, it will be possible to reveal time-dependent kinetic regulation of transcription in normal and diseased cells. The outcome may revolutionize our current understanding of transcriptional regulation occurring in healthy and diseased cells, thereby benefiting the treatment of human diseases.

Name of idea submitter and other team members who worked on this idea:
Jinsong Zhang

Voting

to date, the existing markets lack a clinically-suitable human cardiomyocyte source with adequate myocardium regenerative potential, which has been the major setback in developing safe and effective cell-based therapies for regenerating the damaged human heart in cardiovascular disease.

Given the limited capacity of the heart for self-repair or renewal, cell-based therapy represents a promising therapeutic approach closest to provide a cure to restore normal heart tissue and function for CVD. There is no evidence that adult stem/precursor/progenitor cells derived from mature tissues, such as bone marrow, cord blood, umbilical cord, mesenchymal stem cells, patients’ heart tissue, placenta, or fat tissue, are able to give rise to the contractile heart muscle cells following transplantation into the heart. Despite numerous reports about cell populations expressing stem/precursor/progenitor cell markers identified in the adult hearts, the minuscule quantities and growing evidences indicating that they are not genuine heart cells and that they give rise predominantly to non-functional smooth muscle cells rather than functional contractile cardiomyocytes have caused skepticism if they can potentially be harnessed for cardiac repair. In recent years, reprogrammed or trans-differentiated adult cells, as a result of being backed by excess sum of government and private funding, have been rekindled as the adult alternates. However, major drawbacks such as abnormal gene expression, accelerated aging, immune rejection, not graftable, and extremely low efficiencies, have severely impaired the utility of reprogrammed or trans-differentiated somatic cells as viable therapeutic approaches.

Feasibility and challenges of addressing this CQ or CC:

Opportunity: Derivation of pluripotent human embryonic stem cells (hESCs) from the IVF leftover embryos has brought a new era of cellular medicine for the heart. The intrinsic ability of a hESC for both unlimited self-renewal and differentiation into clinically-relevant lineages makes it a practically inexhaustible source of replacement cells for human tissue and function restoration. Therefore, it has been regarded as an ideal source to provide a large supply of functional human cells to heal the damaged or lost tissues that have naturally limited capacity for renewal, such as the human heart and the human brain. Although a vast sum of NHLBI funding has been spent on looking for adult alternates, such as reprogramming and trans-differentiation of fibroblasts or mature tissues, so far, only human cardiac stem/precursor/progenitor cells derived from embryo-originated hESCs have shown such cellular pharmacologic utility and capacity adequate for myocardium regeneration in pharmaceutical development of stem cell therapy for the damaged human heart.

Name of idea submitter and other team members who worked on this idea:
Xuejun Parsons

Voting

What are the best inroads for the NHLBI to support innovative approaches in the next 5-10 years, especially blood cell therapies based on hematopoietic stem cell and novel gene therapy approaches to control or even cure HIV infection?

HIV control or possibly even HIV cure could result from developing novel cell therapies, especially hematopoietic stem cell (HSC) transplants, and might also result from early use of antiretroviral therapy in acutely HIV-infected individuals.

• Transplantation of HSC including engineered cells has the potential to eradicate HIV reservoirs for HIV cure: the Berlin patient treated with HSC transplant remains free of HIV and is still the only patient cured of HIV infection as of today;

• Identification of acute HIV infections through routine blood donor screening and early anti-retroviral therapy for identified HIV-infected donors can limit or even prevent the establishment of HIV reservoirs.

Feasibility and challenges of addressing this CQ or CC:

• The Berlin patient has provided the proof of concept that HIV infection can be eradicated, that is, sterilizing cure can be achieved, through HSC transplantation in combination with other therapies;

• Recent studies have shown that early identification of HIV infection and treatment of infected individuals with anti-retroviral therapy as soon as possible can significantly limit the size of the HIV reservoirs even if such early treatment may not be able to completely prevent the establishment of HIV reservoirs; routine blood donor screening for both anti-HIV antibodies and HIV RNA among blood donors offers unique opportunities to identify acute HIV infections.

For HIV cure, the challenges include:

• Generation of HIV-resistant HSCs in adequate quantity for transplantation;

• Efficiency of homing and expansion of HIV-resistant HSC transplants;

• Efficiency in replacing HIV-infected cells, including CD4+ resting cells as the major HIV reservoirs, with HIV-resistant HSCs following transplantation;

Longitudinal cohorts of SCD patients, spanning childhood and adulthood, with biobanking DNA, plasma, and serum, and standardized clinical and imaging assessments will allow identification predictors of negative clinical outcomes. An NHLBI-funded national SCD clinical registry with biobanking will be necessary to validate any surrogate endpoints.

Name of idea submitter and other team members who worked on this idea:
Monica Hulbert

Voting

We have all witnessed the success of the National Cancer Institute (NCI) funded Children's Oncology Group - an organization that has made tremendous advancements in the care of children with cancer, very rare compared to sickle cell disease. COG has been able to not only create a database of the numerous studies, but has the unique ability to make "smaller" institutions feel important as is evident by patient enrollment.
...more »

Millions of people in the U.S and throughout the world have sickle cell trait, yet other than its impact on athletes and the recent finding that it may significantly raise the risk of chronic kidney disease, little is known about the trait’s effect on the health of those who carry it. Additional research is needed to further elucidate the implications of sickle cell trait alone, in combination with other genetic tendencies or in response to certain environmental factors. Findings can be used to provide evidence-based clinical guidance for the millions of people who may be affected

Feasibility and challenges of addressing this CQ or CC:

Addressing this question is feasible. Obtaining sufficient long-term data to answer these questions may be challenging.

Name of idea submitter and other team members who worked on this idea:
The Sickle Cell Association of New Jersey

RLD is a major risk factor for death in adults, but there is minimal knowledge of the sequelae of contributing factors. There is no longitudinal study to demonstrate the risk factors, determinants, biological. A cross sectional study of adults could determine prevalence of lung function abnormalities, obstructive and restrictive, using standardized testing and understand the factors associated with the presence of these abnormalities. This study could be associated with a clinical trial of treatment of RLD with outcomes of symptom reduction as well as improvement of the restriction.

Name of idea submitter and other team members who worked on this idea:
ATS Member

Voting

There are approximately 100,000 individuals living with sickle cell disease in the US, however study after study has shown that many lack access to the few existing evidence based interventions such as hydroxyurea. We need to investigate novel ways to increase acess to hematology care and disease modifying therapies.

It has been reported for many decades that the sickle cell trait population are an asymptomatic group; however, there have been an increasing number of reports in the media and the medical literature suggesting the opposite.

Name of idea submitter and other team members who worked on this idea:
Sickle Cell Warriors, Inc. community members

To extend our knowledge of the pathobiology of heart, lung, blood, and sleep disorders and enable clinical investigations that advance the prediction, prevention, preemption, treatment, and cures of human disease.